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Molecular Researches on Ischemic Stroke

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A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Neurobiology".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 28867

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Dr. Valentina Arnao

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Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Via Gaetano la Loggia n.1, 90129 Palermo, Italy
Interests: stroke; extrapiramidal syndromes; sex differences in neurological disorders
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Special Issue Information

Dear Colleagues,

Stroke has become a serious issue for health systems in addition to a major cause of death and adult long-term disability worldwide; in order to establish effective treatments, understanding the wide range of molecular pathways leading to neuronal death or enhancing damage is one of the important goals in stroke research. Critical points for stroke physiopathology are local hypoxia that damages brain tissue and neuronal death. Reperfusion therapies, the only available treatments for ischemic stroke, work only directly on the first mechanism, decreasing neuronal death via the quick recovery of blood flow in a therapeutic time window. Reperfusion treatments outside of a therapeutic time window could result in a hemorrhagic transformation. Many mechanisms are involved independently or in combination in stroke neuronal death, including excitotoxicity, mitochondrial death pathways, the release of free radicals, protein misfolding, apoptosis, necrosis, autophagy, and inflammation. The loss of astrocytes, as well as injury to white matter, may play a crucial role in stroke physiopathology. Potential drugs for stroke are agents that could provide the inhibition of cell death pathways.

This Special Issue of the International Journal of Molecular Sciences aims to provide new avenues into molecular research on ischemic stroke. A better knowledge of the molecular pathways involved may be useful to develop new effective treatments without the limitation of reperfusion therapy (time window, hemorrhagic transformation) for stroke, or new ones that work in synergy with standard therapy. Submissions highlighting each of these topics are welcome. Clinical and basic science contributions, consisting of original papers or reviews, will be equally considered.

Dr. Valentina Arnao
Guest Editor

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Keywords

ischemic stroke
molecular pathway
brain damage and neuronal death
excitotoxicity and apoptosis
inflammation
autophagy

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Published Papers (11 papers)

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Research

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21 pages, 18196 KiB

Open AccessArticle

TMT and PRM Based Quantitative Proteomics to Explore the Protective Role and Mechanism of Iristectorin B in Stroke

by Meizhu Zheng, Mi Zhou, Tingting Lu, Yao Lu, Peng Qin and Chunming Liu

Int. J. Mol. Sci. 2023, 24(20), 15195; https://doi.org/10.3390/ijms242015195 - 15 Oct 2023

Viewed by 1686

Abstract

Stroke is a serious disease caused by the rupture or blockage of the cerebrovascular system. Its pathogenesis is complex and involves multiple mechanisms. Iristectorin B is a natural isoflavone that has certain anti stroke effects. In this study, an in vitro stroke injury model of glyoxylate deprivation was established using PC12 cells, which was used to evaluate the anti-stroke activity of Iristectorin B in ejecta stem. The results showed that Iristectorin B, a natural isoflavone derived from Dried Shoot, significantly reduced the damage to PC12 cells caused by oxygen glucose deprivation/reoxygenation, decreased apoptosis, enhanced cell survival and reduced Ca²⁺, LDH and ROS levels. The results showed that Iristectorin B had a significant protective effect on Na₂S₂O₄-injured PC12 cells, and the mechanism may be related to the protective effect of neurons in the brain. After protein extraction and various analyses were performed, a series of cutting-edge technologies were organically combined to study the quantitative proteome of each group. Differential proteins were then analyzed. According to the protein screening principle, ferroptosis-related proteins were most closely associated with stroke. The differential proteins associated with ferroptosis screened were SLC3A2, TFR1 and HMOX1, with HMOX1 being the most significantly elevated and reduced via dosing. Iristectorin B may act as a protective agent against stroke by regulating ferroptosis, and SLC3A2, TFR1 and HMOX1 may serve as potential diagnostic biomarkers for stroke, providing additional evidence to support the importance of ferroptosis in stroke. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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19 pages, 2604 KiB

Open AccessArticle

Dihydropyrimidinase-Related Protein 2 Is a New Partner in the Binding between 4E-BP2 and eIF4E Related to Neuronal Death after Cerebral Ischemia

by Emma Martínez-Alonso, Alejandro Escobar-Peso, Natalia Guerra-Pérez, Marcel Roca, Jaime Masjuan and Alberto Alcázar

Int. J. Mol. Sci. 2023, 24(9), 8246; https://doi.org/10.3390/ijms24098246 - 4 May 2023

Viewed by 1809

Abstract

Transient cerebral ischemia induces neuronal degeneration, followed in time by secondary delayed neuronal death that is strongly correlated with a permanent inhibition of protein synthesis in vulnerable brain regions, while protein translational rates are recovered in resistant areas. In the translation-regulation initiation step, the eukaryotic initiation factor (eIF) 4E is a key player regulated by its association with eIF4E-binding proteins (4E-BPs), mostly 4E-BP2 in brain tissue. In a previous work, we identified dihydropyrimidinase-related protein 2 (DRP2) as a 4E-BP2-interacting protein. Here, using a proteomic approach in a model of transient cerebral ischemia, a detailed study of DRP2 was performed in order to address the challenge of translation restoration in vulnerable regions. In this report, several DRP2 isoforms that have a specific interaction with both 4E-BP2 and eIF4E were identified, showing significant and opposite differences in this association, and being differentially detected in resistant and vulnerable regions in response to ischemia reperfusion. Our results provide the first evidence of DRP2 isoforms as potential regulators of the 4E-BP2–eIF4E association that would have consequences in the delayed neuronal death under ischemic-reperfusion stress. The new knowledge reported here identifies DRP2 as a new target to promote neuronal survival after cerebral ischemia. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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16 pages, 993 KiB

Open AccessArticle

Association between PAI-1 Polymorphisms and Ischemic Stroke in a South Korean Case-Control Cohort

by Gun Ho Choi, Sung Hwan Cho, Hui Jeong An, Han Sung Park, Jeong Yong Lee, Eun Ju Ko, Seung Hun Oh, Ok Joon Kim and Nam Keun Kim

Int. J. Mol. Sci. 2023, 24(9), 8041; https://doi.org/10.3390/ijms24098041 - 28 Apr 2023

Cited by 2 | Viewed by 2529

Abstract

Stroke is the second leading cause of death in the world. Approximately 80% of strokes are ischemic in origin. Many risk factors have been linked to stroke, including an increased level of plasminogen activator inhibitor-1 (PAI-1). PAI-1 levels increase and remain elevated in blood during the acute phase of ischemic stroke, which can impair fibrinolytic activity, leading to coronary artery disease and arterial thrombotic disorders. Here, we present a case-control study of 574 stroke patients and 425 controls seen for routine health examination or treatment for nonspecific dizziness, nonorganic headache, or anxiety for positive family history of stroke at the Bundang Medical Center in South Korea. Polymorphisms in PAI-1 were identified by polymerase chain reaction/restriction fragment length polymorphism analysis using genomic DNA. Specifically, three variations (−675 4G>5G, 10692T>C, and 12068G>A) were linked to a higher overall prevalence of stroke as well as a higher prevalence of certain stroke subtypes. Haplotype analyses also revealed combinations of these variations (−844G>A, −675 4G>5G, 43G>A, 9785A>G, 10692T>C, 11053T>G, and 12068G>A) that were significantly associated with a higher prevalence of ischemic stroke. To the best of our knowledge, this is the first strong evidence that polymorphic sites in PAI-1 promoter and 3′-UTR regions are associated with higher ischemic stroke risk. Furthermore, the PAI-1 genotypes and haplotypes identified here have potential as clinical biomarkers of ischemic stroke and could improve the prognosis and future management of stroke patients. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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23 pages, 3017 KiB

Open AccessArticle

Inter-Alpha Inhibitor Proteins Modify the Microvasculature after Exposure to Hypoxia–Ischemia and Hypoxia in Neonatal Rats

by Francesco Girolamo, Yow-Pin Lim, Daniela Virgintino, Barbara S. Stonestreet and Xiaodi F. Chen

Int. J. Mol. Sci. 2023, 24(7), 6743; https://doi.org/10.3390/ijms24076743 - 4 Apr 2023

Cited by 4 | Viewed by 1909

Abstract

Microvasculature develops during early brain development. Hypoxia–ischemia (HI) and hypoxia (H) predispose to brain injury in neonates. Inter-alpha inhibitor proteins (IAIPs) attenuate injury to the neonatal brain after exposure to HI. However, the effects of IAIPs on the brain microvasculature after exposure to HI have not been examined in neonates. Postnatal day-7 rats were exposed to sham treatment or right carotid artery ligation and 8% oxygen for 90 min. HI comprises hypoxia (H) and ischemia to the right hemisphere (HI-right) and hypoxia to the whole body, including the left hemisphere (H-left). Human IAIPs (hIAIPs, 30 mg/kg) or placebo were injected immediately, 24 and 48 h after HI/H. The brains were analyzed 72 h after HI/H to determine the effects of hIAIPs on the microvasculature by laminin immunohistochemistry and calculation of (1) the percentage area stained by laminin, (2) cumulative microvessel length, and (3) density of tunneling nanotubes (TNTs), which are sensitive indicators of the earliest phases of neo-vascularization/collateralization. hIAIPs mainly affected the percent of the laminin-stained area after HI/H, cumulative vessel length after H but not HI, and TNT density in females but not males. hIAIPs modify the effects of HI/H on the microvasculature after brain injury in neonatal rats and exhibit sex-related differential effects. Our findings suggest that treatment with hIAIPs after exposure to H and HI in neonatal rats affects the laminin content of the vessel basal lamina and angiogenic responses in a sex-related fashion. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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13 pages, 2053 KiB

Open AccessArticle

Spinal Stroke: Outcome Attenuation by Erythropoietin and Carbamylated Erythropoietin and Its Prediction by Sphingosine-1-Phosphate Serum Levels in Mice

by Leon-Gordian Koepke, Edzard Schwedhelm, Wiebke Ibing, Alexander Oberhuber, Guenter Daum, Brigitta Vcelar, Hubert Schelzig and Florian Simon

Int. J. Mol. Sci. 2022, 23(17), 9558; https://doi.org/10.3390/ijms23179558 - 23 Aug 2022

Viewed by 2084

Abstract

Spinal strokes may be associated with tremendous spinal cord injury. Erythropoietin (EPO) improves the neurological outcome of animals after spinal cord ischemia (SCI) and its effects on ischemia-induced endoplasmic reticulum (ER) stress and the unfolded protein response (UPR) are considered possible molecular mechanisms. Furthermore, sphingosin-1-phosphate (S1P) is suggested to correlate with SCI. In this study, the effect of recombinant human EPO (rhEPO) and carbamylated EPO (cEPO-Fc) on the outcome of mice after SCI and a prognostic value of S1P were investigated. SCI was induced in 12-month-old male mice by thoracic aortal cross-clamping after administration of rhEPO, cEPO-Fc, or a control. The locomotory behavior of mice was evaluated by the Basso mouse scale and S1P serum levels were measured by liquid chromatography-tandem mass spectrometry. The spinal cord was examined histologically and the expressions of key UPR proteins (ATF6, PERK, and IRE1a, caspase-12) were analyzed utilizing immunohistochemistry and real-time quantitative polymerase chain reaction. RhEPO and cEPO-Fc significantly improved outcomes after SCI. The expression of caspase-12 significantly increased in the control group within the first 24 h of reperfusion. Animals with better locomotory behavior had significantly higher serum levels of S1P. Our data indicate that rhEPO and cEPO-Fc have protective effects on the clinical outcome and neuronal tissue of mice after SCI and that the ER is involved in the molecular mechanisms. Moreover, serum S1P may predict the severity of impairment after SCI. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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12 pages, 1916 KiB

Open AccessArticle

Histology of Cerebral Clots in Cryptogenic Stroke Varies According to the Presence of a Patent Foramen Ovale

by Johanna Härtl, Maria Berndt, Holger Poppert, Friederike Liesche-Starnecker, Katja Steiger, Silke Wunderlich, Tobias Boeckh-Behrens and Benno Ikenberg

Int. J. Mol. Sci. 2022, 23(16), 9474; https://doi.org/10.3390/ijms23169474 - 22 Aug 2022

Cited by 1 | Viewed by 1980

Abstract

Although a pathophysiological impact remains difficult to prove in individual patient care, a patent foramen ovale (PFO) is currently considered of high relevance for secondary prophylaxis in selected patients with cryptogenic ischemic stroke. By quantification of histological clot composition, we aimed to enhance pathophysiological understanding of PFO attributable ischemic strokes. Retrospectively, we evaluated all cerebral clots retrieved by mechanical thrombectomy for acute ischemic stroke treatment between 2011 and 2021 at our comprehensive stroke care center. Inclusion criteria applied were cryptogenic stroke, age (≤60 years), and PFO status according to transesophageal echocardiography, resulting in a study population of 58 patients. Relative clot composition was calculated using orbit image analysis to define the ratio of main histologic components (fibrin/platelets (F/P), red blood cell count (RBC), leukocytes). Cryptogenic stroke patients with PFO (PFO+, n = 20) displayed a significantly higher percentage of RBC (0.57 ± 0.17; p = 0.002) and lower percentage of F/P (0.38 ± 0.15; p = 0.003) compared to patients without PFO (PFO–, n = 38) (RBC: 0.41 ± 0.21; F/P: 0.52 ± 0.20). In conclusion, histologic clot composition in cryptogenic stroke varies depending on the presence of a PFO. Our findings histologically support the concept that a PFO may be of pathophysiological relevance in cryptogenic ischemic stroke. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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Review

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16 pages, 2976 KiB

Open AccessReview

Multi-Level Biomarkers for Early Diagnosis of Ischaemic Stroke: A Systematic Review and Meta-Analysis

by Qianyun Li, Lingyun Zhao, Ching Long Chan, Yilin Zhang, See Wai Tong, Xiaodan Zhang, Joshua Wing Kei Ho, Yaqing Jiao and Timothy Hudson Rainer

Int. J. Mol. Sci. 2023, 24(18), 13821; https://doi.org/10.3390/ijms241813821 - 7 Sep 2023

Cited by 3 | Viewed by 2429

Abstract

Blood biomarkers hold potential for the early diagnosis of ischaemic stroke (IS). We aimed to evaluate the current weight of evidence and identify potential biomarkers and biological pathways for further investigation. We searched PubMed, EMBASE, the Cochrane Library and Web of Science, used R package meta4diag for diagnostic meta-analysis and applied Gene Ontology (GO) analysis to identify vital biological processes (BPs). Among 8544 studies, we included 182 articles with a total of 30,446 participants: 15675 IS, 2317 haemorrhagic stroke (HS), 1798 stroke mimics, 846 transient ischaemic attack and 9810 control subjects. There were 518 pooled biomarkers including 203 proteins, 114 genes, 108 metabolites and 88 transcripts. Our study generated two shortlists of biomarkers for future research: one with optimal diagnostic performance and another with low selection bias. Glial fibrillary acidic protein was eligible for diagnostic meta-analysis, with summary sensitivities and specificities for differentiating HS from IS between 3 h and 24 h after stroke onset ranging from 73% to 80% and 77% to 97%, respectively. GO analysis revealed the top five BPs associated with IS. This study provides a holistic view of early diagnostic biomarkers in IS. Two shortlists of biomarkers and five BPs warrant future investigation. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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21 pages, 406 KiB

Open AccessReview

microRNAs Associated with Carotid Plaque Development and Vulnerability: The Clinician’s Perspective

by Rafał Badacz, Tadeusz Przewłocki, Jacek Legutko, Krzysztof Żmudka and Anna Kabłak-Ziembicka

Int. J. Mol. Sci. 2022, 23(24), 15645; https://doi.org/10.3390/ijms232415645 - 9 Dec 2022

Cited by 15 | Viewed by 2501

Abstract

Ischemic stroke (IS) related to atherosclerosis of large arteries is one of the leading causes of mortality and disability in developed countries. Atherosclerotic internal carotid artery stenosis (ICAS) contributes to 20% of all cerebral ischemia cases. Nowadays, atherosclerosis prevention and treatment measures aim at controlling the atherosclerosis risk factors, or at the interventional (surgical or endovascular) management of mature occlusive lesions. There is a definite lack of the established circulating biomarkers which, once modulated, could prevent development of atherosclerosis, and consequently prevent the carotid-artery-related IS. Recent studies emphasize that microRNA (miRNA) are the emerging particles that could potentially play a pivotal role in this approach. There are some research studies on the association between the expression of small non-coding microRNAs with a carotid plaque development and vulnerability. However, the data remain inconsistent. In addition, all major studies on carotid atherosclerotic plaque were conducted on cell culture or animal models; very few were conducted on humans, whereas the accumulating evidence demonstrates that it cannot be automatically extrapolated to processes in humans. Therefore, this paper aims to review the current knowledge on how miRNA participate in the process of carotid plaque formation and rupture, as well as stroke occurrence. We discuss potential target miRNA that could be used as a prognostic or therapeutic tool. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

26 pages, 6081 KiB

Open AccessReview

Need for a Paradigm Shift in the Treatment of Ischemic Stroke: The Blood-Brain Barrier

by Maria Luz Alonso-Alonso, Ana Sampedro-Viana, Sabela Fernández-Rodicio, Marcos Bazarra-Barreiros, Alberto Ouro, Tomás Sobrino, Francisco Campos, José Castillo, Pablo Hervella and Ramón Iglesias-Rey

Int. J. Mol. Sci. 2022, 23(16), 9486; https://doi.org/10.3390/ijms23169486 - 22 Aug 2022

Cited by 8 | Viewed by 4738

Abstract

Blood-brain barrier (BBB) integrity is essential to maintaining brain health. Aging-related alterations could lead to chronic progressive leakiness of the BBB, which is directly correlated with cerebrovascular diseases. Indeed, the BBB breakdown during acute ischemic stroke is critical. It remains unclear, however, whether BBB dysfunction is one of the first events that leads to brain disease or a down-stream consequence. This review will focus on the BBB dysfunction associated with cerebrovascular disease. An added difficulty is its association with the deleterious or reparative effect, which depends on the stroke phase. We will first outline the BBB structure and function. Then, we will focus on the spatiotemporal chronic, slow, and progressive BBB alteration related to ischemic stroke. Finally, we will propose a new perspective on preventive therapeutic strategies associated with brain aging based on targeting specific components of the BBB. Understanding BBB age-evolutions will be beneficial for new drug development and the identification of the best performance window times. This could have a direct impact on clinical translation and personalised medicine. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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Other

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16 pages, 1096 KiB

Open AccessPerspective

Clot Morphology in Acute Ischemic Stroke Decision Making

by Joanna C. Huang and Sonu M. M. Bhaskar

Int. J. Mol. Sci. 2022, 23(20), 12373; https://doi.org/10.3390/ijms232012373 - 15 Oct 2022

Cited by 5 | Viewed by 3353

Abstract

Stroke is a leading cause of death and disability in the world, and the provision of reperfusion therapy and endovascular therapy, in particular, have revolutionized the treatment of patients with stroke and opened opportunities to look at brain clots retrieved after the procedure. The use of histopathology and molecular profiling of clots is of growing research and clinical interest. However, its clinical implications and incorporation within stroke workflows remain suboptimal. Recent studies have indicated that the study of brain clots may inform the mechanism of stroke and hence guide treatment decision-making in select groups of patients, especially patients without a defined cause or known mechanism. This article provides a comprehensive overview of various clot histopathological examinations in acute stroke-care settings, their clinical utility, and existing gaps and opportunities for further research. We also provide targeted recommendations to improve clot analysis workflow, hence standardizing its incorporation into clinical practice. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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Graphical abstract

17 pages, 15594 KiB

Open AccessCase Report

Mystery(n) Phenotypic Presentation in Europeans: Report of Three Further Novel Missense RNF213 Variants Leading to Severe Syndromic Forms of Moyamoya Angiopathy and Literature Review

by Claudia Santoro, Giuseppe Mirone, Mariateresa Zanobio, Giusy Ranucci, Alessandra D’Amico, Domenico Cicala, Maria Iascone, Pia Bernardo, Vincenzo Piccolo, Andrea Ronchi, Giuseppe Limongelli, Marco Carotenuto, Vincenzo Nigro, Giuseppe Cinalli and Giulio Piluso

Int. J. Mol. Sci. 2022, 23(16), 8952; https://doi.org/10.3390/ijms23168952 - 11 Aug 2022

Cited by 2 | Viewed by 2438

Abstract

Moyamoya angiopathy (MMA) is a rare cerebral vasculopathy in some cases occurring in children. Incidence is higher in East Asia, where the heterozygous p.Arg4810Lys variant in RNF213 (Mysterin) represents the major susceptibility factor. Rare variants in RNF213 have also been found in European MMA patients with incomplete penetrance and are today a recognized susceptibility factor for other cardiovascular disorders, from extracerebral artery stenosis to hypertension. By whole exome sequencing, we identified three rare and previously unreported missense variants of RNF213 in three children with early onset of bilateral MMA, and subsequently extended clinical and radiological investigations to their carrier relatives. Substitutions all involved highly conserved residues clustered in the C-terminal region of RNF213, mainly in the E3 ligase domain. Probands showed a de novo occurring variant, p.Phe4120Leu (family A), a maternally inherited heterozygous variant, p.Ser4118Cys (family B), and a novel heterozygous variant, p.Glu4867Lys, inherited from the mother, in whom it occurred de novo (family C). Patients from families A and C experienced transient hypertransaminasemia and stenosis of extracerebral arteries. Bilateral MMA was present in the proband’s carrier grandfather from family B. The proband from family C and her carrier mother both exhibited annular figurate erythema. Our data confirm that rare heterozygous variants in RNF213 cause MMA in Europeans as well as in East Asian populations, suggesting that substitutions close to positions 4118–4122 and 4867 of RNF213 could lead to a syndromic form of MMA showing elevated aminotransferases and extracerebral vascular involvement, with the possible association of peculiar skin manifestations. Full article

(This article belongs to the Special Issue Molecular Researches on Ischemic Stroke)

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